Trauma from Occlusion: Types, Causes, and Effects on Periodontal Health

Trauma From Occlusion

Following are the types of TFO:

Depending on mode of onset:

• Acute trauma from occlusion
• Chronic trauma from occlusion.

Depending on capacity of periodontium to resist occlusal forces:

• Primary trauma from occlusion
• Secondary trauma from occlusion.

Acute Trauma from Occlusion

• Acute trauma from occlusion refers to periodontal changes associated with an abrupt occlusal impact such as that produced by biting on a hard object.
• In addition, restorations or prosthetic appliances that interfere with or alter the direction of occlusal forces on the teeth may also induce acute trauma.
• Acute trauma results in tooth pain, sensitivity to percussion, and increased tooth mobility.
• If the force is dissipated by a shift in the position of the tooth or by the wearing away or correction of the restoration, then the injury heals, and the symptoms subside. Otherwise, periodontal injury may worsen and develop into necrosis accompanied by periodontal abscess formation, or it may persist as a symptom-free chronic condition.
• Acute trauma can also produce cementum tears

Chronic Trauma from Occlusion

• Chronic trauma from occlusion refers to periodontal changes which are associated with gradual changes in occlusion caused by tooth wear, drifting movement, and extrusion of the teeth in combination with parafunctional habits (e.g., bruxism, clenching) rather than as a sequela of acute periodontal trauma.
• Chronic trauma from occlusion is more common than the acute form and of greater clinical signifiance.
• It can be primary or secondary.

Primary Trauma from Occlusion

• When trauma from occlusion is the result of alterations in occlusal forces, it is known as primary trauma from occlusion.
• Primary trauma from occlusion happens if trauma from occlusion is considered the primary etiologic factor in periodontal destruction and if only local alteration to which a tooth is subjected is a result of occlusion.
• Examples include periodontal injury produced around teeth with a previously healthy periodontium after the following:
  • High filling surfaces
  • Prosthetic replacement that creates excessive forces on abutment and antagonistic teeth
  • Drifting movement or extrusion of teeth into spaces created by unreplaced missing teeth
  • Orthodontic movement of teeth into functionally unacceptable positions.
  • Changes produced by primary trauma do not alter the level of connective tissue attchment and do not initiate pocket formation because the supracrestal gingival fibers are not affected and therefore prevent the apical migration of the junctional epithelium.

Secondary Trauma from Occlusion

• Secondary trauma from occlusion occurs when the adaptive capacity of the tissues to withstand occlusal forces is impaired by bone loss that results from marginal inflammation.
• This decreases periodontal attachment area and alters the leverage on the remaining tissues.
• The periodontium becomes more vulnerable to injury and previously well-tolerated occlusal forces become traumatic.